2015 ISAKOS Biennial Congress ePoster #1140
Arthroscopic Multi-Ligament Reconstruction for Knee Dislocation
xiong Li, MD, PhD, Changsha, Hunan CHINA
Hongbing Lu, MD, PhD, Changsha CHINA
Guanghua Lei, MD, PhD, Changsha CHINA
Dept. Sports Medicine, Xiangya Hospital, Central Sourth University, changsha, hunan, CHINA
FDA Status Cleared
Summary: Arthroscopic multi-ligament reconstruction for knee dislocation
To investigate the surgical treatments of knee dislocation and analyze arthroscopic multi-ligament reconstruction to restore the function of knee.
From June 2009 to Jan 2014, we treated 37 patients with knee dislocation (including 6 patients with subluxation). There are 25 males and 12 females. The average age was 37.33 ± 2.67 years. First reset operation was performed during 4 hours to 1.5 months after injury, including four cases with dislocation for more than 3 weeks (old dislocation). There were six cases with combined injuries of popliteal vessels and nerve. Five cases were cured after reset and followed conservative treatment and one case was treated with routine vessel repair and external fixation. After manipulative reduction, these patients were treated with brace and joint function rehabilitation. There are 12 cases with interlocking joints. They were treated with arthroscopic exploration and joint capsule meniscal repair. Rehabilitation duration was 2.5-6 months, with an average of 4.32 ± 0.25 months. After the joint mobility reached more than 80% of normal joints, the ligaments reconstruction was performed. The average HSS knee function score 45.54 ± 12.34 points. The Lysholm knee score was 36.33 ± 10.58 points. These patients were reviewed by preoperative knee MRI and then arthroscopic multiple ligament reconstruction. All patients had meniscus and were treated with arthroscopic repair or suturing. 21 cases were treated with combined anterior cruciate ligament and lateral collateral ligament reconstruction. 7 cases were treated with combined anterior cruciate ligament and medial collateral ligament reconstruction. 5 cases were treated with combined anterior cruciate ligament, lateral collateral ligament and medial collateral ligament reconstruction. 3 cases were treated with combined anterior cruciate ligament, lateral collateral ligament and popliteofibular ligament reconstruction. 1 case was treated with patellar tendon repair. Patients were allowed brace treatment for 8-12 weeks and following rehabilitation training 6-12 months.
The mean operative time was 3.45 ± 0.34 hours. The average blood loss was 142.67 ± 22.65 ml. No wound was infected. All patients were followed 6-18 months, with an average 9.53 months. The HSS knee function score was 87.64 ± 7.16 points and the lysholm knee score was 83.67 ± 11.02 at the last follow-up. There were excellent in 27 cases, good in 6 cases, mild in 3 cases and poor in 1 case. The good rate was 89.19%. There was significantly improved knee function after surgery (P <0.01). One case with poor results was a 58-year-old female patient, because of the delay reduction, joint pain ligament reconstruction surgery, concurrent traumatic osteoarthritis. Knee arthroplasty was performed for this patient after failure of conservative treatment. All 37 cases of patients had no dislocation angina in the knee.
Early knee dislocation reduction and proper handling of associated injuries such as neurovascular injury are very important. For patients with interlocking joint, arthroscopic exploration and joint capsule meniscal repair are necessary. After good joint function recovery, arthroscopic surgical reconstruction of the ruptured ligaments is need to restore the joint stability.